Scottish Improvement Skills Prioritisation

System of Profound Knowledge Deming 2000

Prioritisation By the end of this session you will be able to: use a 2 x 2 matrix (eg Difficulty vs Impact) to prioritise change ideas or drivers Identify opportunities to use Pareto charts, and analyse Pareto charts to generate and prioritise change ideas.

Prioritisation Impact/difficulty matrix Pareto chart

Prioritisation Impact/difficulty matrix Pareto chart

Matrix: impact vs difficulty High Low   Easy Hard Difficulty

Driver diagram Aim 1 Driver 2 Driver Change ideas A new healthier me! Lose 7 pounds by end July 2015 Leisure activity Calories in meals Calories in drinks Calories in alcohol Work activity Calories in snacks No alcohol Monday to Thursday Max 1 x juice or soft drink per day Reduce portion size Cook evening meals from scratch Replace biscuits/cakes with fruit Keep to shopping list Get up from desk to talk, instead of phone or email Use stairs not lift Walk to a daily step target Swim at least twice a week Calories in Calories out

New, healthier me! Impact High Low Easy Hard Difficulty   Easy Hard Difficulty Reduce portion size Swim twice / week No alcohol Mon – Thurs Keep to shopping list Cook from scratch 1 soft drink / day Increase steps Replace biscuits with fruit Use stairs at work

Matrix: impact vs difficulty High Low   Easy Hard Difficulty

Prioritisation Impact/difficulty matrix Pareto chart

What is a Pareto chart? 80:20

When to use a Pareto chart When you can categorise items that have the potential to contribute to the improvement you are considering When you want to analyse data about the frequency of problems

Access to primary care

Primary care practice X: reasons given by patients for not attending

Primary care practice X: reasons given by patients for not attending Number % cumulative % Unable to contact to cancel 35 24% Forgot 26 18% 43% Unaware of appointment 23 16% 59% Confusion about appointment time 19 13% 72% Inconvenient day 12 8% 80% Other 9 6% 87% Unwell 6 4% 91% Inconvenient time 4 3% 94% No value in appointment 97% Working 3 2% 99% No transport 1 1% Unable to afford time off work 100% Total 143

Primary care practice X: reasons given by patients for not attending

Primary care practice X: reasons given by patients for not attending

Central Hospital Ward F: Percentage of meals returned, by meal type (2013)

Ward X: Adverse drug events - causes

Hospital X: SAB cases by ward (SAB = Staphylococcus aureus bacteraemia)

When to use a Pareto chart When you can categorise items that have the potential to contribute to the improvement you are considering When you want to analyse data about the frequency of problems When you have at least 30 observations across the categories (vertical axis) Consider: measure, period, existing data

Pareto chart examples For this project, what data could a Pareto chart be used with? Which driver(s) or change idea(s) is this Pareto chart related to? Which categories would you focus your improvement efforts on? What action would you take based on this chart?

Project work: prioritise Would a Pareto chart be useful for your project? If so, what data would you need, and how could you get it? Use the Impact vs Difficulty matrix to identify your top priority for change.

Prioritisation: summary Impact/difficulty matrix Pareto chart

References and further resources Pareto chart http://www.ihi.org/resources/Pages/Tools/ParetoDiagram.aspx